Healthcare Provider Details

I. General information

NPI: 1184887200
Provider Name (Legal Business Name): DELORES H. ODELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 SOUTH STATE HIGHWAY 395
LONE PINE CA
93545-0128
US

IV. Provider business mailing address

PO BOX 128
LONE PINE CA
93545-0128
US

V. Phone/Fax

Practice location:
  • Phone: 760-937-0937
  • Fax:
Mailing address:
  • Phone: 760-937-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT16512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: